Tuesday, July 17, 2012

Methadone is Now the Biggest Killer

By

Peter R. Coleman, M.D.

The
number of people killed by Methadone is startling. Consider this - Methadone
accounts for only 2% of all painkiller prescriptions, but it causes over 30% of
all deaths! And lately, there have been
a lot of deaths from painkillers. In
2009, there were over 15,500 Americans killed from opiate painkillers. In fact, there are now more Americans killed
by prescription painkillers than all other drugs combined.

Two
questions arise.Why is there such an
increase in deaths from Methadone, and what can be done about it? The answer to the first question is fairly
easy. The answer to the second question
is more complicated.

Methadone
has been available as a treatment for opiate addiction for a number of decades. It has unique properties that make it a
useful treatment, both to help patients detoxify off Heroin and other short
acting opiates. Its properties also make
it useful as a maintenance drug for patients who are not ready, or able, to
become completely drug free. Methadone
is active orally, so it does not need to be injected or snorted to have its
effect. Methadone has a very long
half-life - it varies from patient to patient, but Methadone’s half-life can be
up to 6 days - which is to say that it acts in the body for a very, very long
time. When a drug has a long half-life,
it easily accumulates in the body every time you take another dose - increasing
the risk for an overdose. The long
half-life of Methadone is both a good and a bad thing.

The
good news about Methadone’s long half-life is that it only needs to be taken
once a day, making it ideal for use in clinics where the patient is given their
medicine under observation. Second, drugs
with long half-lives also do not give as much of a pleasurable high when they
are taken, because quick highs seem to be more addicting. In general terms, addicts like the feeling of
rapidly going up, which is one of the reasons that cocaine is so addictive. So,
Methadone is able to be given in a clinic once-a-day and the clients don’t get
too much of a buzz from it.

But
the long half-life is also the biggest problem with Methadone – it accumulates.
There have always been quite few deaths at
Methadone clinics – almost always in the first few days of starting patients on
it. If a dose is given that is too high
for the patient, and the patient keeps getting that same dose every day, then
the blood level will keep rising for over a week. It is not uncommon that if patients start on a
dose of 60mg daily and get that dose daily, they die of an overdose within the
first week. Good Methadone clinics start
patients at very low doses and see the patients daily until they are out of
this danger zone, even if it means not fully abolishing their withdrawal
symptoms in the first few days.

The
long half-life also means that Methadone is not a very effective painkiller. When patients are in pain, they want relief
quickly. A drug that has its peak effect
24-hours later is not going to be very effective to relieve pain. If patients don’t feel much pain relief, it is
very tempting for them to take another dose – a situation that can cause severe
problems with accumulation. Patients can
easily overdose and die if they keep taking Methadone to try to relieve all of
their pain.

The
other reason that there are more Methadone deaths is that there is a lot more
of it available on the streets. It has
become quite fashionable for pain clinics and other doctors to prescribe
Methadone for chronic pain patients. The drug is cheap and physicians like the
fact that patients are not getting much of a buzz from their pain meds. So there is a lot of Methadone being prescribed,
often by very conscientious physicians, and this means there is a lot more out
there. This means that there is going to
be more sold. I think the latest price
for Methadone is about $10 per pill.

Street
abuse of Methadone is rampant. Addicts
like it. There is a lot available and it
is relatively inexpensive. Whereas it
may cost addicts $100 daily to get high with Heroin or Oxycodone, addicts can
frequently relieve their withdrawal symptoms for only about $30 a day. This is probably the most common form of abuse
of Methadone. Most addicts know that
they are not going to get much of a buzz from Methadone, but it is usually
available when other drugs are not available and it is lot cheaper. Addicts frequently use Methadone to keep their
costs down and then use Heroin or OxyContin when they want to catch a good
buzz.

When
a long-acting opiate is used frequently, it is going to cause a lot of deaths. The deaths come predominantly in three ways. If enough Methadone is taken, it stops the
person’s breathing. Even more of a
problem is when Methadone is taken with other sedatives, including alcohol. This combination of Methadone plus sedatives
is particularly lethal because both drugs can suppress breathing and the
combination suppresses breathing very powerfully. The third way Methadone is fatal is that it
can cause a blockage in the rhythm of the heart – a prolonged QT interval. Sometimes this happens at high doses (good
clinics should periodically check an EKG on their patients), but sometimes it
can happen unexpectedly even at lower doses.

Unfortunately,
trying to do something about the number of fatalities caused by Methadone is
not easy. Obviously, authorities should
crack down on physicians who are fraudulently prescribing it, but most patients
are getting their prescriptions quite legally. For patients who have chronic pain that
requires opiate medication, there are no perfect solutions. What we have found at The Coleman Institute is
that many chronic pain patients don’t require opiates at all. They actually feel better and have less pain
after we detox them and put them on Naltrexone therapy. That is one solution that doesn’t have any
side effects!

At The Coleman Institute, we love to help people get clean and stay clean. If you or
someone you love is in need of detox from opiates, alcohol, benzos, Methadone,
or Suboxone, please do not hesitant to call Jennifer Pius
at 1-877-77-DETOX (33869). We are here to help you and yours get clean
and stay clean!

About Me

The Coleman Institute, the Advanced Center for Addiction Treatment, is recognized as one of the most successful and innovative outpatient accelerated detox centers for addiction treatment in the country with 10 offices in the U.S.
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